Provider Demographics
NPI:1659249464
Name:HAMILTON, MCKINZI BROOKE
Entity type:Individual
Prefix:
First Name:MCKINZI
Middle Name:BROOKE
Last Name:HAMILTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6018 HEATHER AVE
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:VA
Mailing Address - Zip Code:24084-2262
Mailing Address - Country:US
Mailing Address - Phone:540-629-3830
Mailing Address - Fax:
Practice Address - Street 1:6018 HEATHER AVE
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:VA
Practice Address - Zip Code:24084-2262
Practice Address - Country:US
Practice Address - Phone:540-629-3830
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-10-24
Last Update Date:2025-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305216487225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist